Hospital Activity Data Brief intro to what ISD do – Collect and store national data and statistical information for NHS Wales Collected data is analysed and converted to useful information that helps staff across NHS Wales and the Welsh Government in their work Example of data provided...slide 2 Keith Howkins, Information Services Department NHS Wales Informatics Service

Average daily occupied beds and number of hospital admissions for a selection of Welsh hospitals Where does this data come from?

Where Does This Data Come From? Average Daily Occupied Beds – QS1 Database Admissions – PEDW Database QS1 PEDW – Patient Episode Database for Wales Look at each of these in a bit more detail...

Average Daily Occupied Beds – QS1 Database What data is held in QS1? - All beds in NHS hospitals in Wales - Aggregate level dataset - Figures include average daily occupied beds, staffed beds allocated and deaths and discharges, all broken down by specialty Welsh residents treated in England are excluded from the data, but non-Welsh residents treated in NHS hospitals in Wales are included. Hospitals just submit aggregated figures for fields, rather than record level Data includes average daily occupied beds, staffed beds allocated and deaths and discharges, all broken down by specialty So, how is this data collected?

Average Daily Occupied Beds – QS1 Database How is QS1 data collected? - Health Boards are required to submit data on the last working day of the month - This is for the previous month’s activity Example, October 31st’s submission is for September’s data An e-mail is sent to the contacts a week before the deadline date as a reminder and also to request that they inform us of any issues with meeting deadlines/software problems etc. How do the health boards submit the data?

Average Daily Occupied Beds – QS1 Database How is QS1 data collected? - Health Boards enter their data through a Web Based system, iQS1 Requires a log in and password Only one person in a provider has a log in, this is to stop duplicate information being input When they log in, they’re presented with a screen like this...

Average Daily Occupied Beds – QS1 Database How is QS1 data collected? They add the data by simply clicking in the boxes and adding the relevant figures Once all the data has been entered, they press a button to run validation checks on the data. These compare the current month’s data against the previous month’s. This returns a screen like this ...

Average Daily Occupied Beds – QS1 Database How is QS1 data collected? ...with validation queries and a comments box. They will be unable to sign off their data until a comment is entered against each query. Once these are complete, the month is signed off and the data is loaded on to our databases for analysis

Average Daily Occupied Beds – QS1 Database How is QS1 data collected? - When the month’s submissions have been signed off, that month is ‘locked’ For example, if we refer to the example of the report I showed earlier...

Average Daily Occupied Beds – QS1 Database Bronglais’ average daily occupied beds has not changed between March and July’s refresh

Average Daily Occupied Beds – QS1 Database - Health Boards can amend previous month’s data - They have to email us to request the relevant month is unlocked However, that said, it is possible for health boards to amend previous months if they need to Have to email us to request the relevant month is unlocked and give a reason ...or a data quality issue is picked up - This is normally done if they have missed some data from a previous month’s submission

Average Daily Occupied Beds – QS1 Database Prince Charles has – they discovered some data missing, and in May, requested the financial year 2013/14 be unlocked so they could correct the months accordingly. However, this is the exception to the rule – of the 17 hospitals included in the data sent out, only Prince Charles and Royal Glamorgan unlocked and changed their previous data between March and July’s refreshes. So, in general, when a month’s QS1 figures are signed off, those are the figures for that month, it is not often they change Going back to the original report I showed...

the second data item was the number of hospital admissions the second data item was the number of hospital admissions. This is from the PEDW database

Hospital Admissions - PEDW What data is held in PEDW? All day case and inpatient activity for patients in NHS Wales hospitals Hospital activity for Welsh residents treated in hospitals in England - (Although report for Maggie is based on inpatients only) Includes both elective and emergency admissions How is this collected? Data from 1997 onwards

Hospital Admissions - PEDW How is PEDW Data Collected? Data is collected and coded at each hospital Each hospital has a Patient Administrative System in which they record information about the patient and their stay in hospital Some examples of the PEDW data items they record on their PAS...

Hospital Admissions - PEDW Examples of information collected on PAS System: Patient’s Date of Birth Admission Date Sex Admission Method Address Patient Class NHS Number Consultant GP Specialty of Care Referrer Discharge Date Decision to Admit Date Discharge Method Duration of Elective Wait Discharge Destination

Hospital Admissions - PEDW How is PEDW Data Collected? After the patient is discharged, the hand written patient notes are transcribed by a clinical coder into medical codes: - ICD10 Diagnosis codes In addition to this... Diagnosis codes detail what was wrong with the patient. The main symptom is recorded as the primary diagnosis. There are 14 possible diagnoses codes on PEDW OPCS codes detail any operations the patient had. The main operation that took place is recorded as the principal procedure. There are 12 possible procedure codes on PEDW How is the information collected submitted to us? - OPCS codes

Hospital Admissions - PEDW How is PEDW Data Collected? Each hospital is mandated to submit the data they have collected to the national PEDW database on a monthly basis They submit their data through a site called the Switching Service The deadline for these submissions is the 17th of the month

Hospital Admissions - PEDW How is PEDW Data Collected? Switching Service: Each provider has an account on the Switching Service They can upload their data to this at any time via secure file upload, and run validation checks on it. Examples of validation checks – invalid date of birth, invalid specialty code, invalid site code of treatment, invalid/uncoded primary diagnosis 3 months after episode end date How do the organisations check any errors that are flagged by the validation checks?

Hospital Admissions - PEDW How Organisations Check Their Errors Able to download validation errors directly from Switching Service Can validate and resubmit data as many times as they wish Records signed off by the 17th of the month get loaded in that month’s data load. So, one possible cause of delayed data submissions is if there are a lot of validation errors, and the organisation has to go back and investigate. How many records get loaded each month? Sign off their records when happy with the validity of the data

Hospital Admissions - PEDW How Many Records Get Submitted per Month? Episode End Month Episodes Sep-14 93482 Aug-14 5326 Jul-14 178 Jun-14 12 May-14 25 Apr-14 -11 Mar-14 4 Feb-14 -4 Jan-14 Dec-13 1 Nov-13 7 Oct-13 3 Sep-13 -2 Aug-13 Jul-13 Jun-13 Roughly 100,000 new episodes are loaded each month Unlike the QS1 data, previous month’s aren’t locked, and organisations can submit data for previous month’s For example, a table of the episodes loaded as part of the October refresh. 93482 episodes (roughly 94% of the month’s submissions) were for September, with 5326 (5%) for August, and 178 for July. After three months, the number of episodes tail off. The reason for this is that the number of episodes per month (usually around 100,000) means there is generally a bit of a backlog. Health Boards have a target of getting 95% of their records fully coded, with primary diagnoses and principal procedure within 3 months of the episode end date. So, going back to the original report, to what extent does a refresh effect the data...

Hospital Admissions - PEDW How Much Does the Data Change After A Refresh? Difference for Jan ‘13 down to ABM resubmitting due to data quality issues In general, data doesn’t change a great deal further back than three months prior to the current refresh Maybe some differences for the latest couple of months. This is due to the sheer number of records being input causing backlogs for the latest couple of months. Normally takes providers a couple of months to get up to speed, so I’d advise caution if using data from the last couple of month’s, bear in mind the figures are likely to change In addition to the 12 monthly refreshes, there is an additional refresh in July

Hospital Admissions - PEDW Welsh Costing Returns In addition to the 12 monthly refreshes on the 17th, there is an additional refresh in July This is for the Welsh Costing Returns. Health Boards try to get their records for the previous financial year as complete as possible as they get paid based on this This is for the Welsh Costing Returns For the 2013-14 WCR in July, all providers deleted all of their data and resubmitted to get their data as complete as possible This can cause a slight increase in the summer for the number of episodes in the previous financial year, table to show the effect this has...

Hospital Admissions - PEDW Welsh Costing Returns   After June '14 Refresh After July '14 WCR Refresh Increase Apr-13 89657 89789 132 May-13 92597 92678 81 Jun-13 87418 87488 70 Jul-13 96382 96444 62 Aug-13 88577 88640 63 Sep-13 89718 89830 112 Oct-13 96640 96673 33 Nov-13 90943 91032 89 Dec-13 86822 86926 104 Jan-14 93148 93173 25 Feb-14 85173 85185 12 Mar-14 92967 93004 37 Differences round 50-100 mark per month, but this is only about 0.1% of the monthly total After the WCR refresh, we consider the previous financial year sufficiently complete, and make a frozen copy of the data, which we use for our online publications. So in effect, we have two PEDW databases, a frozen database up to the end of the previous financial year which we use for our online publications, and a more dynamic database up to the previous month, which we use for ad hoc analysis, with the caveat that the data can change as health boards can continue to resubmit historic data indefinitely, although in practice generally only the last two or three months are effected significantly.

Summary Average Daily Occupied Beds from QS1 dataset QS1 data submitted on last working day of month, for previous month Previous months are locked Providers occasionally request for them to be unlocked so they can correct omissions

Summary Hospital Admissions from PEDW PEDW Data submitted on 17th of month Providers can resubmit historic data indefinitely Roughly 94% of episodes submitted are for the previous month, 5% for month prior to that Due to large number of episodes (100,000 per month) creating a backlog And after this, we freeze a copy of the database to use for our online publications Welsh Costing Returns cause about a 0.1% increase in previous financial year

Useful Links and Contacts NWIS Information and Statistics Website: www.infoandstats.wales.nhs.uk Contact: publications@wales.nhs.uk